Background
Over 50% of people with HIV (PWH) in the United States (US) are older than 50 years and are at risk for a high lifetime burden of physical frailty, falls, and fall-related fractures. However, data on the long-term clinical and economic consequences of these events are sparse. We projected the survival gains and economic benefits of preventing physical frailty, falls, and fall-related fractures among aging PWH in the US.
Methods
We developed and validated a microsimulation model (FraPol) to project survival outcomes and costs associated with preventing physical frailty, falls, and fall-related fractures in people with virologically suppressed HIV in the US age 40+ (519,640 people). We used data from HAILO, MACS, WIHS, and published literature to inform model parameters. Fall risk (18% average annual risk) and risk of injury or fracture after a fall (17% and 8%, respectively) were estimated from HAILO. Costs and effects of frailty and fractures on mortality were from published literature. We compared the status quo with three scenarios, removing: (1) physical pre-frailty/frailty, (2) falls without fracture, and (3) fall-related fractures. For each scenario, we calculated survival gains and impact on remaining lifetime frailty-, fall-, and fracture-related costs (non-discounted) as the difference in outcomes compared to the status quo.
Results
We projected that people with virologically suppressed HIV aged 40+ (mean age 56y) in the US would have a remaining life expectancy of 20.5 years, with an average of 11.8 years, or ~60% of their remaining lifespan, with pre-frailty or frailty. There would be an average of 11.0 lifetime falls and 0.4 fall-related fractures per person. Preventing pre-frailty and frailty would increase survival by 5.6 years, on average, and preventing fall-related fractures would increase survival by 0.4 years. Among PWH in the US age 40+, we projected that preventing pre-frailty and frailty would result in 2.9 million life-years gained and $16.2 billion saved. Preventing falls without fracture would save $2.3 billion, and preventing fall-related fractures would result in 221,600 life-years gained and $2.5 billion saved.
Conclusions
The burden of frailty, falls, and fall-related fractures among PWH in the US will be substantial. Effective interventions to prevent frailty, falls, and fractures may improve survival, and savings could in part offset other health-related spending.
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